In June, Portugal’s Directorate-General of Health (DGS) issued a warning about a rise in hepatitis A virus transmission in the country, with 504 cases reported between January 1 and May 31, aligning with the European Centre for Disease Prevention and Control’s reports of active outbreaks across various European nations.
As stated by the health authority, a new immunization strategy unveiled on Friday aims to “reduce the incidence of hepatitis A” and “decrease morbidity and mortality” associated with the infection, particularly among “vulnerable groups and/or those with a higher risk of exposure.”
The strategy also seeks to prevent outbreaks in high-risk communities or contexts and “promote access to vaccination against hepatitis A for groups at increased risk of exposure and/or severe disease,” as outlined in the DGS guidelines.
Based on the current epidemiological landscape of hepatitis A in Portugal and recommendations from the Vaccination Technical Commission (CTV), these DGS guidelines update the recommended vaccination schemes against hepatitis A in the contexts of pre-exposure, post-exposure, and outbreak, as well as under the National Vaccination Program (PNV).
In Portugal, vaccination against this infection is advised for groups at increased risk of exposure or severe disease, provided free of charge for pre- and post-exposure situations, including outbreak management.
Within the PNV framework, the hepatitis A vaccine should be administered in specific situations where it is provided at no cost.
“In the context of travel medicine, vaccination should be maintained through an individualized medical prescription and acquired at community pharmacies,” the published guideline on the DGS website states.
It further emphasizes that “the administration of normal human immunoglobulin (IgHN)1 can be considered, upon medical prescription and with informed consent, in specific situations, particularly when the vaccine is unavailable or contraindicated.”
To ensure access to hepatitis A vaccination for defined risk groups, eligible individuals for vaccination may be identified through various means, including “self-proposed vaccination.”
“Individuals who believe they are at risk of contracting hepatitis A may contact a vaccination point to propose themselves for vaccination,” it explains.
Given the particular nature of this practice, the DGS advises that healthcare professionals responsible for administering the vaccine should conduct an individual risk assessment prior to vaccination.
According to the DGS, vaccination should occur as soon as possible after the last exposure, ideally within 14 days, and should be conducted as a priority.
Hepatitis A often presents asymptomatically or mildly in children under five, but in adults, it can manifest abruptly with symptoms such as fever, malaise, and abdominal pain, with jaundice—yellowing of the skin and eyes—being the most characteristic sign.
The DGS notes that there is no chronic form of the disease, and infection grants lifetime immunity.
Pre-exposure vaccination is the primary prevention method, especially recommended for individuals residing or traveling to endemic areas or those with active outbreaks, engaging in sexual practices with a heightened infection risk, and those with chronic illnesses or other conditions that may worsen the clinical course of the infection.
Post-exposure vaccination targets close contacts of confirmed cases, following national guidelines and eligibility criteria, aiming to prevent secondary case development.
